CMS is granting a weather-related Special Enrollment Period for select counties in Florida, Georgia, South Carolina, and North Carolina that may have been affected by severe weather.
The affected counties are home to a high number of residents who are eligible for Medicare Advantage, and who may have been unable to sign up due to weather events.
The SEPs run either until the end of 2019 or until the end of January 2020. Click below to download details on the affected counties and their associated SEPs.
More info from CMS
CMS provides a Special Enrollment Period (SEP) for individuals affected by severe weather. This will benefit those who need to enroll in, disenroll from or switch Medicare health or prescription drug plans and have missed another enrollment period (e.g., either aging in or an SEP) due to the weather event. For those who qualify, the SEP begins on the first day of the incident period and runs for four (4) full months from the beginning of the incident period.
Who qualifies for this SEP?
This weather-related SEP applies to individuals who:
- Reside, or resided at the start of the incident period, in an area for which FEMA has declared an Emergency or a Major Disaster and has designated affected counties as eligible to apply for Individual or Public level assistance; and
- Had another valid election period at any time during the incident period; and
- Did not make an election during that other valid election period.
What Does This Mean to Agents?
If an individual wants to enroll and believes they may qualify for this SEP, agents should:
- Ask the beneficiary if they can show proof that they lived/live in an impacted area at the start of the incident period.
- If they do not have proof, ask them to verbally attest.
- Confirm that they had another election period available during the time of the incident period.
- Confirm that the beneficiary lived in a county that has been declared an emergency or major disaster, and FEMA has determined is eligible for Public or Individual assistance. Once eligibility has been verified, proceed with the application.
- On applications, use election code SEP DST.
Enrollments made pursuant to this SEP are effective the first of the month following the receipt of the enrollment request. For enrollment requests where more than one enrollment effective date is possible, agents will need to determine the applicant’s desired effective date.
Reminder: These SEPs are only available to beneficiaries who were affected during the incident period and should not be used as a tool to generate new enrollments.
For any updates to eligible counties, please refer to the FEMA website at https://www.fema.gov/disasters
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